Disruptive Mood Dysregulation Disorder Research Articles

Autonomic response and attachment style in disruptive mood dysregulation disorder.

Disruptive mood dysregulation disorder (DMDD) is characterised by severe emotion regulation difficulties, particularly anger and irritability, in children. Despite the impact of attachment on emotional and behavioural regulation, the link between attachment style and DMDD is under-researched. This study investigated whether attachment style and parasympathetic regulation differentiate the response profiles to frustrating conditions between children diagnosed with DMDD and controls. Participants were assessed at schools in Johannesburg, Gauteng, South Africa. Thirty participants were divided into two matched groups (n DMDD = 15; n Control = 15) and assessed. Respiratory sinus arrhythmia (RSA) and heart period were measured during an Affective Posner Task, inducing frustration. Attachment style was assessed using the Attachment Style Classification Questionnaire for children. Parents of children with DMDD completed a social interaction problems questionnaire. The DMDD group showed a higher prevalence of avoidant attachment style (p = 0.013) compared to controls. Both groups displayed adaptive vagal withdrawal and recovery during the task (p = 0.005; p = 0.021). Controls had significantly higher heart period throughout the assessment (game 1: p = 0.006; game 2: p = 0.013; game 3: p = 0.007). In the DMDD group, lower vagal tone during frustration correlated with more social interaction problems (p = 0.049). The study demonstrates a potential link between attachment style and altered physiological state in children with DMDD. The findings provide insight into possible atypical vagal regulation of the heart and avoidant attachment styles in DMDD, highlighting potential therapeutic and intervention targets.

Current Understandings and Controversies of Disruptive Mood Dysregulation Disorder

Researching DMDD is crucial as it directly impacts clinical diagnosis and treatment strategies for mental illnesses. Understanding and addressing the controversies surrounding DMDD can lead to improved diagnostic criteria and better treatment outcomes for affected individuals. Through a comprehensive and extensive understanding of DMDD through literature search, it is found that there is a great dispute in the academic circle about the rationality and scientificity of DMDD. Based on this, the existing research results of DMDD will be partially introduced, and some existing controversies will be discussed. The main points of contention are the scientificity and rationality of DMDD’s inclusion in the DSM-5; And how the distinction between DMDD and other disorders is more rigorous because it involves different ways of treating different types of mental illness. Understanding these disputes is essential as they have significant implications for clinical practice and the overall approach to diagnosing and treating mental health disorders. Addressing these controversies can lead to improved diagnostic accuracy and more effective, tailored treatment strategies for individuals with DMDD.

Diagnostic accuracy of large language models in psychiatry

IntroductionMedical decision-making is crucial for effective treatment, especially in psychiatry where diagnosis often relies on subjective patient reports and a lack of high-specificity symptoms. Artificial intelligence (AI), particularly Large Language Models (LLMs) like GPT, has emerged as a promising tool to enhance diagnostic accuracy in psychiatry. This comparative study explores the diagnostic capabilities of several AI models, including Aya, GPT-3.5, GPT-4, GPT-3.5 clinical assistant (CA), Nemotron, and Nemotron CA, using clinical cases from the DSM-5. MethodsWe curated 20 clinical cases from the DSM-5 Clinical Cases book, covering a wide range of psychiatric diagnoses. Four advanced AI models (GPT-3.5 Turbo, GPT-4, Aya, Nemotron) were tested using prompts to elicit detailed diagnoses and reasoning. The models' performances were evaluated based on accuracy and quality of reasoning, with additional analysis using the Retrieval Augmented Generation (RAG) methodology for models accessing the DSM-5 text. ResultsThe AI models showed varied diagnostic accuracy, with GPT-3.5 and GPT-4 performing notably better than Aya and Nemotron in terms of both accuracy and reasoning quality. While models struggled with specific disorders such as cyclothymic and disruptive mood dysregulation disorders, others excelled, particularly in diagnosing psychotic and bipolar disorders. Statistical analysis highlighted significant differences in accuracy and reasoning, emphasizing the superiority of the GPT models. DiscussionThe application of AI in psychiatry offers potential improvements in diagnostic accuracy. The superior performance of the GPT models can be attributed to their advanced natural language processing capabilities and extensive training on diverse text data, enabling more effective interpretation of psychiatric language. However, models like Aya and Nemotron showed limitations in reasoning, indicating a need for further refinement in their training and application. ConclusionAI holds significant promise for enhancing psychiatric diagnostics, with certain models demonstrating high potential in interpreting complex clinical descriptions accurately. Future research should focus on expanding the dataset and integrating multimodal data to further enhance the diagnostic capabilities of AI in psychiatry.

Disruptive mood dysregulation disorder, parental stress, and attachment styles

Disruptive mood dysregulation disorder (DMDD) is a relatively new diagnostic entity concerning children with chronic irritability and severe anger outbursts. Currently, there is limited knowledge about the parental factors associated with the disorder. The aim of this study was to compare stress levels and attachment styles in parents of children with DMDD with those of parents of children with other diagnoses. Our sample consisted of 218 children (6–12 years, Mage = 9.68 years) referred to child mental health outpatient clinics. Clinicians used a standardized semi-structured diagnostic interview to identify diagnoses. Parental stress levels and attachment styles were assessed using parent reports. We found that parents of children with DMDD experience significantly higher levels of parenting stress related to factors in the child than parents of children with other diagnoses. Furthermore, parents of children with DMDD show a higher association with insecure adult attachment styles than parents of children without DMDD. Finally, an adult preoccupied-ambivalent attachment style explains the variability in parental stress in the DMDD group to a large degree. We discuss how parental stress and an insecure attachment style can be associated with negative parenting practices. An implication from this study could be that treatment results might be improved by involving parents more in treatment programs for children with DMDD.

Assessment of affective dysregulation in children: development and evaluation of a semi-structured interview for parents and for children

BackgroundChildren with affective dysregulation (AD) show an excessive reactivity to emotionally positive or negative stimuli, typically manifesting in chronic irritability, severe temper tantrums, and sudden mood swings. AD shows a large overlap with externalizing and internalizing disorders. Given its transdiagnostic nature, AD cannot be reliably and validly captured only by diagnostic categories such as disruptive mood dysregulation disorder (DMDD). Therefore, this study aimed to evaluate two semi-structured clinical interviews—one for parents and one for children.MethodsBoth interviews were developed based on existing measures that capture particular aspects of AD. We analyzed internal consistencies and interrater agreement to evaluate their reliability. Furthermore, we analyzed factor loadings in an exploratory factor analysis, differences in interview scores between children with and without co-occurring internalizing and externalizing disorders, and associations with other measures of AD and of AD-related constructs. The evaluation was performed in a screened community sample of children aged 8–12 years (n = 445). Interrater reliability was additionally analyzed in an outpatient sample of children aged 8–12 years (n = 27).ResultsOverall, internal consistency was acceptable to good. In both samples, we found moderate to excellent interrater reliability on a dimensional level. Interrater agreement for the dichotomous diagnosis DMDD was substantial to perfect. In the exploratory factor analysis, almost all factor loadings were acceptable. Children with a diagnosis of disruptive disorder, attention-deficit/hyperactivity disorder, or any disorder (disruptive disorder, attention-deficit/hyperactivity disorder, and depressive disorder) showed higher scores on the DADYS interviews than children without these disorders. The correlation analyses revealed the strongest associations with other measures of AD and measures of AD-specific functional impairment. Moreover, we found moderate to very large associations with internalizing and externalizing symptoms and moderate to large associations with emotion regulation strategies and health-related quality of life.ConclusionsThe analyses of internal consistency and interrater agreement support the reliability of both clinical interviews. Furthermore, exploratory factor analysis, discriminant analyses, and correlation analyses support the interviews’ factorial, discriminant, concurrent, convergent, and divergent validity. The interviews might thus contribute to the reliable and valid identification of children with AD and the assessment of treatment responses.Trial registrationADOPT Online: German Clinical Trials Register (DRKS) DRKS00014963. Registered 27 June 2018.

Disruptive mood dysregulation disorder: the relationship between cardiac vagal tone, emotion recognition, and expressive prosody

Children with disruptive mood dysregulation disorder have difficulties with emotion regulation and recognition which impacts their social functioning. Due to its recent definition, there is limited information on the neural mechanisms of this disorder. This exploratory study examined the role of autonomic heart regulation in children with disruptive mood dysregulation disorder, motivated by suggestions of reduced autonomic regulation (measured by heart rate variability) associated with psychiatric disorders in adults and children. The cross-sectional design sampled two groups of children, one with disruptive mood dysregulation disorder ( n = 15; 14 male) and the other with typical development ( n = 15; 14 male). Heart rate variability, facial emotion recognition accuracy and speed, and prosody were measured. There were no significant differences in heart rate variability between the two groups before, or during, the tasks. However, children with disruptive mood dysregulation disorder experienced significantly greater difficulty recognising fear in faces compared to controls and confused other negatively valenced emotions. There was also a significant, negative correlation between heart rate variability and prosody modulation (verbal expression of emotion) in the control group, a relationship that was absent in the disruptive mood dysregulation disorder group. These results suggest that atypical autonomic regulation during emotionally evocative situations and difficulty with facial emotion recognition may contribute to the challenges experienced by children with disruptive mood dysregulation disorder. This is valuable knowledge for psychologists, which can contribute to individualised, effective, and comprehensive care that addresses the child’s emotional, social, and relational well-being.

Prevalence and comorbidities of disruptive mood dysregulation disorder

IntroductionFollowing the release of DSM-5 in 2013, a newly introduced diagnostic category emerged in psychiatric classification—the disruptive mood dysregulation disorder (DMDD). DMDD is a depressive disorder that begins in childhood and is marked by a consistently irritable or angry mood, frequently accompanied by temper outbursts that are notably severe.ObjectivesIt is to study the prevalence and comorbidities of DMDD in Morocco, specifically at Arrazi University Psychiatric HospitalMethodsData were collected from youths aged 6 to 18 years who underwent a systematic assessment of symptoms. This assessment was extended to all patients consulting at Arrazi Hospital in Salé within the pediatric department over a period of four months (sample accrued from July 2023 to October 2023). The diagnosis of DMDD was established utilizing the diagnostic criteria outlined in DSM-5ResultsAbout 31% of the young participants met the operational criteria for DMDD. Those with DMDD exhibited increased comorbidity rates with attention-deficit/hyperactivity disorder (ADHD), another Depressive disorder and conduct disorder compared to those without DMDD. Additionally, they displayed elevated symptoms of aggressive behavior, rule-breaking, social issues, anxiety/depression, attention problems, and thought problems in comparison to all other participants without DMDD. It’s noteworthy that youth with DMDD presented with at least one psychiatric comorbidity.ConclusionsGiven that DMDD is accompanied by other comorbid psychiatric disorders, particularly depression and anxiety, and appears to impact familial and occupational status in adulthood, the early detection and subsequent effective treatment of DMDD symptoms are of utmost importance.Disclosure of InterestNone Declared

Evaluation of Neurocognitive Functions of Children and Adolescents Diagnosed with Pediatric Bipolar Disorder and Disruptive Mood Dysregulation and at High Risk for Bipolar Disorder

IntroductionPediatric Bipolar Disorder (BPD) is a chronic psychiatric disorder that alters normal and psychological development processes among patients. Although cognitive deficits in BPD have identified in recent studies, little is known about the developmental trajectory of these deficits. DMDD is a newly defined diagnosis included in the DSM-V. Since it added a new dimension to the clinical spectrum but few studies conducted on DMDD, there are some conflicting discussions in the literature about how to distinguish this disorder from other childhood psychiatric disorders and how to treat it.ObjectivesThe aim of this study was to determine the phenomenological and neuropsychological differences between children and adolescents with a diagnosis of BPD (Pediatric Bipolar Disorder), DMDD (Disruptive Mood Dysregulation Disorder), and children and adolescents who are genetically at high risk for Bipolar Disorder (BD), and healthy controls (HCs) who do not have any psychiatric diagnosis, to investigate endophenotypes that may be predictive for BD.MethodsOur study sample consists of four groups, the BPD group (n=30), the Risk group (n=25), the DMDD group (n=36), and the Healthy Control group (n=29). All participants were evaluated by the “Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children—Now and Lifetime Pattern (K-SADS-PL)”. “Young Mania Rating Scale/Parent Form (YMRS-ABF), Conner’s Parent Rating Scale (CPRS-48), Child and Adolescent Behavior Rating Scale (CBCL)” scales were filled by parents, and “Child Depression Inventory (CDI), Youth Self-Report Form for 11-18 Years Olds (YSR)” scales were filled by children and adolescents. Neurocognitive test battery was applied to each participant: Continuous Performance Test (CPT), Wisconsin Card Sorting Test (WCST), Stroop Color and Word Test (SCWT), Trait Making Test A and B sections (TMT-A/B), California Verbal Learning Test-Child version (CVLT-C).ResultsWhile it was determined that the cases in the BPD and DMDD groups performed significantly worse in CPT, SCWT, CVLT-C, TMT A/B tests compared to healthy controls, it was found that the subjects in the Risk group performed worse at the CPT test than healthy controls. In addition, the cases in the BPD, Risk and DMDD groups reported more clinical and behavioral problems than the healthy controls.ConclusionsThere is a significant deterioration in the areas of continuous attention, processing speed, cognitive flexibility, response prevention, verbal memory and working memory in the BPD and DMDD groups, and in the continuous attention area in the Risk group compared to healthy controls. Prospective follow-up and imaging studies using larger samples and a larger neurocognitive test battery in the future will better reveal the neuropsychological characteristics of the BPD, Risk and DMDD groups.Disclosure of InterestNone Declared

Developing and Implementing a Web-Based Branching Logic Survey to Support Psychiatric Crisis Evaluations of Individuals With Developmental Disabilities: Qualitative Study and Evaluation of Validity.

Individuals with developmental disabilities (DD) experience increased rates of emotional and behavioral crises that necessitate assessment and intervention. Psychiatric disorders can contribute to crises; however, screening measures developed for the general population are inadequate for those with DD. Medical conditions can exacerbate crises and merit evaluation. Screening tools using checklist formats, even when designed for DD, are too limited in depth and scope for crisis assessments. The Sources of Distress survey implements a web-based branching logic format to screen for common psychiatric and medical conditions experienced by individuals with DD by querying caregiver knowledge and observations. This paper aims to (1) describe the initial survey development, (2) report on focus group and expert review processes and findings, and (3) present results from the survey's clinical implementation and evaluation of validity. Sources of Distress was reviewed by focus groups and clinical experts; this feedback informed survey revisions. The survey was subsequently implemented in clinical settings to augment providers' psychiatric and medical history taking. Informal and formal consults followed the completion of Sources of Distress for a subset of individuals. A records review was performed to identify working diagnoses established during these consults. Focus group members (n=17) expressed positive feedback overall about the survey's content and provided specific recommendations to add categories and items. The survey was completed for 231 individuals with DD in the clinical setting (n=161, 69.7% men and boys; mean age 17.7, SD 10.3; range 2-65 years). Consults were performed for 149 individuals (n=102, 68.5% men and boys; mean age 18.9, SD 10.9 years), generating working diagnoses to compare survey screening results. Sources of Distress accuracy rates were 91% (95% CI 85%-95%) for posttraumatic stress disorder, 87% (95% CI 81%-92%) for anxiety, 87% (95% CI 81%-92%) for episodic expansive mood and bipolar disorder, 82% (95% CI 75%-87%) for psychotic disorder, 79% (95% CI 71%-85%) for unipolar depression, and 76% (95% CI 69%-82%) for attention-deficit/hyperactivity disorder. While no specific survey items or screening algorithm existed for unspecified mood disorder and disruptive mood dysregulation disorder, these conditions were caregiver-reported and working diagnoses for 11.7% (27/231) and 16.8% (25/149) of individuals, respectively. Caregivers described Sources of Distress as an acceptable tool for sharing their knowledge and insights about individuals with DD who present in crisis. As a screening tool, this survey demonstrates good accuracy. However, better differentiation among mood disorders is needed, including the addition of items and screening algorithm for unspecified mood disorder and disruptive mood dysregulation disorder. Additional validation efforts are necessary to include a more geographically diverse population and reevaluate mood disorder differentiation. Future study is merited to investigate the survey's impact on the psychiatric and medical management of distress in individuals with DD.

Modeling Shared and Specific Variances of Irritability, Inattention, and Hyperactivity Yields Novel Insights Into White Matter Perturbations

Irritability, inattention, and hyperactivity, common presentations of childhood psychopathology, have been associated with perturbed white matter microstructure. However, similar tracts have been implicated across these phenotypes; such non-specificity could be rooted in their high co-occurrence. To address this problem, we employ a bifactor approach parsing unique and shared components of irritability, inattention, and hyperactivity, which we then relate to white matter microstructure. We developed a bifactor model based on the Conners Comprehensive Behavioral Rating Scale in a sample of youth with no psychiatric diagnosis or a primary diagnosis of Attention-Deficit/Hyperactivity Disorder or Disruptive Mood Dysregulation Disorder (N = 521). We applied the model to an independent yet sociodemographically and clinically comparable sample (N = 152), where we tested associations between latent variables and fractional anisotropy (FA). The bifactor model fit well (CFI=.99; RMSEA=.07). The shared factor was positively associated with an independent measure of impulsivity (rS=0.88, pFDR<.001) and negatively related to whole-brain FA (r=-0.20), as well as FA of the corticospinal tract and the anterior thalamic radiation (all pFWE<.05). FA increased with age and deviation from this curve, indicating altered white matter maturation, was associated with the hyperactivity-specific factor (r=-0.16, pFWE<.05). Inattention- and irritability-specific factors were not linked to FA. Perturbed white matter microstructure may represent a shared neurobiological mechanism of irritability, inattention, and hyperactivity related to heightened impulsivity. Further, hyperactivity might be uniquely associated with a delay in white matter maturation.

Antipsychotics in child and adolescent patients with major depressive disorder: A retrospective analysis of prescribing patterns.

Depression rates in children/adolescents in the United States have increased in the last 10 years. Fluoxetine and escitalopram are the only 2 antidepressants approved for the treatment of major depression disorder (MDD) in children/adolescents. In adults, some antipsychotics are approved for augmented treatment of MDD. However, there is limited research on antipsychotic augmentation in child/adolescent MDD. This retrospective chart review evaluated antipsychotic prescribing for MDD in hospitalized patients aged 4 to 17 years to determine the frequency of prescribing antipsychotics for MDD and what factors influence the addition of an antipsychotic. For inclusion, patients were diagnosed with MDD and not on an antidepressant or antipsychotic before admission. Binomial logistic regression was used to analyze variables with prescribed antipsychotics as the dependent variable. There were 6.8% of patients prescribed an antipsychotic. Binomial logistic regression analysis found that increased age (odds ratio [OR] 1.28; 95% CI = 1.045, 1.568; P = .017) and multiple admissions within 1 year (OR 3.277; 95% CI = 2.283, 4.705; P < .001) were associated with the use of antipsychotics in patients with MDD. Posttraumatic stress disorder and disruptive mood dysregulation disorder were also associated with the use of antipsychotics. Careful consideration should be taken when using off-label antipsychotics in children due to limited studies on efficacy. Future research is warranted to assess the efficacy and safety of these agents in children and adolescents.

A Delphi consensus among experts on assessment and treatment of disruptive mood dysregulation disorder.

The aim of this study was to explore consensus among clinicians and researchers on how to assess and treat Disruptive Mood Dysregulation Disorder (DMDD). The Delphi method was used to organize data collected from an initial sample of 23 child psychiatrists and psychologists. Three rounds of closed/open questions were needed to achieve the objective. Fifteen experts in the field completed the whole study. Finally, 122 proposals were validated and 5 were rejected. Globally, consensus was more easily reached on items regarding assessment than on those regarding treatment. Specifically, experts agreed that intensity, frequency, and impact of DMDD symptoms needed to be measured across settings, including with parents, siblings, peers, and teachers. While a low level of consensus emerged regarding optimal pharmacological treatment, the use of psychoeducation, behavior-focused therapies (e.g., dialectical behavior therapy, chain analysis, exposure, relaxation), and systemic approaches (parent management training, family therapy, parent-child interaction therapy) met with a high degree of consensus. This study presents recommendations that reached a certain degree of consensus among researchers and clinicians regarding the assessment and treatment of youths with DMDD. These findings may be useful to clinicians working with this population and to researchers since they also highlight non-consensual areas that need to be further investigated.

Comparison of the Effectiveness of Unified Transdiagnostic Therapy and Reality Therapy on Social Information Processing and Emotion Regulation in Students with Disruptive Mood Dysregulation Disorder

Objective: Disruptive mood dysregulation disorder (DMDD), classified under depressive disorders, leads to functional impairments across various domains and a reduction in mental health during adulthood. The current study aimed to compare the effectiveness of unified transdiagnostic therapy and reality therapy on social information processing and emotion regulation among students with disruptive mood dysregulation disorder. Methods and Materials: The research employed a quasi-experimental design with pre-test, post-test, and follow-up assessments, including a control group. The sample consisted of all 8 to 11-year-old boys diagnosed with DMDD in Isfahan, along with their mothers, who visited the Superior Counseling Center and the Child and Adolescent Home affiliated with the Isfahan Municipal Cultural, Social, and Sports Organization in Spring 2022. Forty-five participants were selected through purposive sampling and then randomly assigned into three groups of fifteen (two experimental and one control group). Research Tools: The research instruments included the Disruptive Mood Dysregulation Diagnostic Scale – Parent Form (DMDDS) (Shahmohammadi et al., 2021), Social Stories (Turkospa &amp; Bryan, 1994), and the Cognitive Emotion Regulation Questionnaire (Garnefski, 2007). The experimental groups received separate interventions (unified transdiagnostic therapy and reality therapy), each consisting of ten 60-minute sessions for the students and thirty-minute sessions for the parents, while the control group received no intervention. Data Analysis: The data were analyzed using SPSS version 23 and repeated measures analysis of variance. Findings: The results indicated that both unified transdiagnostic therapy and reality therapy significantly improved social information processing and both positive and negative emotion regulation in students with DMDD at post-test (p &lt; .01), and these effects were maintained at follow-up (p &lt; .001). No significant difference was found between the two therapeutic methods in this regard. Only the goal clarification aspect of unified transdiagnostic therapy was effective at post-test, showing greater efficacy than reality therapy, though the effectiveness of both therapies was not significant at follow-up. Conclusion: Given the effectiveness of unified transdiagnostic therapy and reality therapy on social information processing and emotion regulation in students with disruptive mood dysregulation disorder, both therapies can be utilized in clinics and specialized counseling centers to improve outcomes for students with this disorder.

Problematization about Disruptive Mood Dysregulation Disorder

Este artigo se propõe a delinear, historicamente, o diagnóstico clínico do Transtorno Disruptivo da Desregulação do Humor (TDDH). Com base no método genealógico, essa categoria diagnóstica é desnaturalizada e recontextualizada em sua origem. Analisa-se o conceito de desregulação do humor a partir da escala CBCL (Childhood Behaviour Checklist), sua identificação como um transtorno bipolar da infância, posterior transformação no diagnóstico de TDDH e subsequente crítica deste, com a proposta de englobar os sintomas de desregulação do humor na infância, no diagnóstico de transtorno opositor-desafiante. Como alternativa, o artigo sugere que o humor irritadiço na infância é um estado afetivo primário, constituindo-se, assim, em uma predisposição orgânica primária. Já a regulação emocional é uma construção adaptativa, que se modela ao longo da vida, gerando apresentações subjetivas diversas.

Differential Effects of Disruptive Mood Dysregulation Disorder Comorbidity in Attention Deficit Hyperactivity Disorder on Social Cognition and Empathy

Objective: This study aimed to investigate social cognition and empathy properties in children among Disruptive Mood Dysregulation Disorder (DMDD) + Attention and Hyperactivity Disorder(ADHD); ADHD and healthy controls from Türkiye. Methods: Twenty-two children with DMDD were compared to matched 30 children with ADHD and 60 healthy controls. We administered Affective Reactivity Index (ARI), KaSi Empathy Scale, Kiddie-SADS, and Reading Mind in the Eyes Test (RMET) to evaluate Theory of Mind skills to all study participants. Results: DMDD + ADHD group had lower performance in ToM skills and empathy than in two groups. The ARI scores were found to be statistically significantly higher in the DMDD group than in two groups. It was also found that ARI, empathy, and ToM scores were significantly related in children with DMDD + ADHD. Conclusion: These results might be important to understand the difficulties in social functioning and interpersonal relationship in children with DMDD and ADHD. Children with DMDD may attend specific therapeutic programs which include specific techniques in social cognition, emotion regulation, and irritability.

A New Behavioral Paradigm for Frustrative Nonreward in Juvenile Mice

BackgroundIrritability, defined as proneness to anger, can reach a pathological extent. It is a defining symptom of disruptive mood dysregulation disorder and one of the most common reasons youths present for psychiatric evaluation and care. Aberrant responses to frustrative nonreward (FNR), the response to omission of expected reward, are central to the pathophysiology of irritability. FNR is a translational construct to study irritability across species. The development of preclinical FNR models would advance mechanistic studies of the important and relatively understudied clinical phenomenon of irritability. MethodsWe used FNR as a conceptual framework to develop a novel mouse behavioral paradigm named alternate poking reward omission. Juvenile mice were exposed to alternate poking reward omission and then examined with a battery of behavioral tests to determine the behavioral effect of FNR. ResultsFNR increased locomotion and aggression regardless of sex. These behavioral changes elicited by FNR resemble the symptoms observed in youth with severe irritability. FNR had no effect on anxiety-like, depression-like, or nonaggressive social behaviors. ConclusionsOur alternate poking reward omission paradigm effectively elevated aggression and locomotion in juvenile mice. These frustration effects are directly related to behavioral symptoms of youth with severe irritability. Our novel behavioral paradigm lays the groundwork for further mechanistic studies of frustration and irritability in rodents.

Emotion Regulation Training on Irritability, Alexithymia, and Interpersonal Problems of Adolescents With Disruptive Mood Dysregulation Disorder

Background: Difficulty regulating emotion has been identified as a trans-diagnostic factor common to various psychiatric diagnoses and behavior problems. This study aims to implement emotion regulation training techniques on adolescents with a disruptive mood disorder, emphasizing the irritability, alexithymia, and interpersonal issues in adolescents with disruptive mood dysregulation disorder. Methods: This quasi-experimental research used a pre-test and post-test design on 30 disruptive mood disorders in Tehran City, Iran, from 2022 to 2023. The participants were selected via simple purposive sampling. They were randomly assigned to two 15-member groups (experimental and control). The intervention group received self-regulation training over two months through eight 90-min group therapy sessions, whereas the control group received no treatment. The data were collected using the Barratt impulsiveness scale (BIS-11), Toronto alexithymia scale (TAS-20), and the inventory of interpersonal problems short-version. The data were analyzed by the SPSS software, version 25, and the multivariate analysis of covariance. Results: As indicated by the results, a significant difference was detected between the groups in terms of irritability (F=26.45, P=0.001, η=0.695), alexithymia (F=38.91, P=0.001, η=0.781), and interpersonal problems (F=31.27, P=0.001, η=0.734). Moreover, according to the alexithymia’s largest effect size (0.781), emotion regulation training had more effect on alexithymia. Conclusion: Based on the results, emotion regulation training can be implemented effectively in clinics and psychological treatment centers. Also, because of using emotion regulation training, it is possible to improve these people’s psychological characteristics and social relations. It is also suggested that relevant organizations train specialists and school counselors accordingly.

Characteristic Similarities of Irritability Between Autism and Disruptive Mood Dysregulation Disorder.

Objective: Irritability in children with autism spectrum disorder (ASD) is prominent and often leads to distress to both autistic children and their families. However, the nature of irritability in autism and the difference from nonautistic children have rarely been examined. This study aimed to investigate the clinical characteristics of irritability in autism, and to compare the symptom profiles with those of disruptive mood dysregulation disorder (DMDD) in nonautistic children. Methods: Fifty-six children aged 7-17 years (mean age 10.36 ± 3.05) were recruited into this study (21 with DMDD, 21 with high-functioning autism [hfASD], and 14 healthy volunteers [HV]). Their parents completed the Aberrant Behavior Checklist-Irritability (ABC-I) subscale and the Strengths and Difficulties Questionnaire (SDQ) parent report form. The ABC-I subscale was analyzed as a whole and broken into subsets (ABC-I-Irritability, ABC-I-Agitation, and ABC-I-Crying). The symptom profiles of irritability and the association with psychosocial difficulties were compared between groups. Results: The ABC-I-Irritability scores of children with hfASD closely matched to those of children with DMDD. In addition, both DMDD and hfASD groups could be differentiated from HV group in five of the six items except "depressed mood." However, in the ABC-I-Agitation scale, children with DMDD, but not hfASD, had higher scores in "Aggressive to other patients and staff" and "Stamps feet while banging objects or slamming doors" than HV. Regarding psychosocial outcomes, irritability in children with DMDD and hfASD were associated with emotional problems as measured by the SDQ. Moreover, irritability in DMDD was associated with conduct problems, and the hfASD group exhibited the similar trend. Conclusions: Symptom profiles of irritability and the associated emotional and conduct problems in children with hfASD were similar to those of DMDD in the nonautistic population. Future studies are warranted to explore the underlying neurophysiological mechanisms of irritability between autistic and nonautistic children for further insight into the nature of irritability in autism.

A cross-sectional analysis of the relationships between anxiety sensitivity and youth irritability: the mediated roles of insomnia and selective attention for threat

BackgroundIrritability is common in multiple psychiatric disorders and is hallmark of disruptive mood dysregulation disorder. Child irritability is associated with higher risk of suicide and adulthood mental health problems. However, the psychological mechanisms of irritability are understudied. This study examined the relationship between anxiety sensitivity and irritability among youth, and further explored three possible mediated factors: selective attention for threat, delayed reward discounting, and insomnia.MethodsParticipants were 1417 students (51.7% male; mean age 13.83 years, SD = 1.48) recruited from one high school in Hunan province, China. Self-report questionnaires were used to measure irritability (The Affective Reactivity Index and The Brief Irritability Test), anxiety sensitivity (The Childhood Anxiety Sensitivity Index), selective attention for threat (The Davos Assessment of Cognitive Biases Scale-attention for threat bias subscale), insomnia (The Youth Self-Rating Insomnia Scale), and delayed reward discounting (The 27-item Monetary Choice Questionnaire). Structural equation modal (SEM) was performed to examine mediated relations.ResultsAnxiety sensitivity was modestly related to irritability and insomnia (r from 0.25 to 0.54) and slightly correlated with selective attention for threat (r from 0.12 to 0.28). However, there is no significant relationship of delayed rewards discounting with anxiety sensitivity and irritability. The results of SEM showed that selective attention for threat (indirect effect estimate = 0.04) and insomnia (indirect effect estimate = 0.20) partially mediate the relationship between anxiety sensitivity and irritability, which explained 34% variation.ConclusionsAnxiety sensitivity is an important susceptibility factor for irritability. Selective attention for threat and insomnia are two mediated mechanisms to understand the relationship between anxiety sensitivity and irritability.

Mediating effect of amygdala activity on response to fear vs. happiness in youth with significant levels of irritability and disruptive mood and behavior disorders.

Irritability, characterized by a tendency to exhibit increased anger, is a common clinical problem in youth. Irritability is a significant clinical issue in youth with various psychiatric diagnoses, especially disruptive behavior, and mood disorders (Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, Conduct Disorder, and Disruptive Mood Dysregulation Disorder). Although there have been previous studies focusing on functional alteration in the amygdala related to irritability, there is no comprehensive model between emotional, neuronal, and behavioral characteristics. Using an functional magnetic resonance imaging (fMRI) procedure, we investigated the relationships between behavioral irritability, selective impairments in processing facial emotions and the amygdala neural response in youth with increased irritability. Fifty-nine youth with disruptive mood and behavior disorder completed a facial expression processing task with an event-related fMRI paradigm. The severity of irritability was evaluated using the Affective Reactivity Index. In the result of behavioral data, irritability, and reaction time (RT) differences between interpreting negative (fear) and positive (happiness) facial expressions were positively correlated. In the fMRI result, youth showed higher activation in the right cingulate gyrus, bilateral cerebellum, right amygdala, right precuneus, right superior frontal gyrus, right middle occipital gyrus, and middle temporal gyrus, during the happiness condition vs. fear condition. No brain region exhibited greater activation in the fear than in the happiness conditions. In the result of the mediator analysis, increased irritability was associated with a longer RT toward positive vs. negative facial expressions. Irritability was also positively associated with the difference in amygdala blood oxygen level-dependent responses between the two emotional conditions (happiness > fear). This difference in amygdala activity mediated the interaction between irritability and the RT difference between negative and positive facial expressions. We suggest that impairment in the implicit processing of facial emotional expressions with different valences causes distinct patterns of amygdala response, which correlate with the level of irritability. These results broaden our understanding of the biological mechanism of irritability at the neural level and provide information for the future direction of the study.